Provider Demographics
NPI:1124059506
Name:LAL, ROOP (MD)
Entity type:Individual
Prefix:
First Name:ROOP
Middle Name:
Last Name:LAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1900
Mailing Address - Country:US
Mailing Address - Phone:618-233-6044
Mailing Address - Fax:618-233-3287
Practice Address - Street 1:340 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1900
Practice Address - Country:US
Practice Address - Phone:618-233-6044
Practice Address - Fax:618-233-3287
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074237207RC0001X
IL036-074237207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16187OtherBCBS MO
42237OtherCMR
2507217OtherSECURE HORIZONS
C41351OtherMERCY
098955OtherHEALTH ALLIANCE
12477OtherESSENCE
236567OtherWELLCARE
37099690002OtherGHP
060009695OtherRR MEDICARE
IL0360742371Medicaid
259513OtherUHC
187709OtherHEALTHLINK
ILC41351Medicare UPIN
098955OtherHEALTH ALLIANCE
ILP05497Medicare PIN
MO16187OtherBCBS MO